Steroids of no consequence in improving ICU outcomes in angioedema patients: CHEST
Delhi: Steroid administration in angioedema patients did not affect the length of intubation, intensive care unit hours, and the total length of hospital stay, suggests a recent study in the journal CHEST. The findings were also presented at the 2020 CHEST Annual Meeting held virtually, October 18 to 21.
Glucocorticoids are used routinely for angioedema treatment but its benefits are not clear. There is not enough evidence for its role in angioedema management. In this study, Asma Jamil and colleagues compared patients who did or did not receive corticosteroids for different angioedema subgroups.
For the purpose, the researchers performed a cohort retrospective analysis. It consisted of a total of 3290 angioedema patients (1241 intubated) across 185 US hospitals from the period of 01/2016-01/2020. Angioedema cases were identified using diagnosis codes and time of intubation was calculated from mechanical ventilation procedure codes. Descriptive analyses of patient's characteristics i.e. sex, age, duration of intubation, frequencies of types of angioedema, intensive care unit hours, steroids administration, and the total length of stay were conducted.
The study included a total of 3,290 angioedema patients, 205 in allergic angioedema, 1,955 in unspecified angioedema, and 1,151 in ACE Inhibitor angioedema.
Key findings of the study include:
- ICU hours: Steroids did not affect ICU hours in any subgroup however, age was found to be a significant fact.
- Assuming all other variables remain constant, we found that for every additional year, a patient with any angioedema would be in the ICU for 0.51 hours longer.
- Total length of stay: steroids did not have a significant effect on the total length of stay in any subgroup.
- Length of intubation: steroids were not found to have a significant effect on the length of intubation in any subgroup.
- Steroids, Age, and sex relationship with the type of angioedema: there were no statistical differences in the rates of steroid use among three subgroups.
- A total of 61% of allergic angioedema, 63% unspecified angioedema, 63% ACE inhibitors induced angioedema and all combined 62.61% of patients received steroids.
- There is an association between intubation time and angioedema type.
- In the ACE Inhibitor subgroup, 58% of patients were not intubated, 9% were intubated for <24 hours, 25% were intubated for 24-96 hours, and 5% were intubated for >96 consecutive hours.
- In the allergic subgroup, 68% of patients were not intubated, 10% were intubated for <24 hours, 19% were intubated for 24-96 hours, and 3% were intubated for >96 consecutive hours.
- In the unspecified subgroup, 64% of patients were not intubated, 9.16% were intubated for <24 hours, 22% were intubated for 24-96 hours, and 5% were intubated for >96 consecutive hours.
"To our knowledge, this is the largest observational study conducted on intubated angioedema patients," wrote the authors.
"Our findings show that steroids were given in 2/3 of intubated angioedema patients without any meaningful outcomes. Steroids use can potentially complicate the clinical picture and expose vulnerable patient populations to side effects," they concluded.
"Large retrospective study analyzing role of steroids use in intubated patients with angioedema," is published in the CHEST journal.
DOI: https://journal.chestnet.org/article/S0012-3692(20)32254-6/fulltext
